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A LJ8-year-old woman is seen for evaluation of thrombocytopenia. She has no history of abnormal bleeding. She has a history of IV drug abuse. On physical exam. there is no lymphadenopathy or palpable splenomegaly. Complete blood count (CBC) shows leu kocyte count of 6.700/pL. hemoglobin 1 3 .7 g/dl. and platelet count LJ6,000/pl. The peripheral blood smear is shown below.
Due to the patient's history of IV drug use, a hepatitis panel and HIV tests are ordered. What would be an appropriate next step in the management of the patient?
- Bone marrow biopsy
- Flow cytometry of peripheral blood
- Liver-spleen scan
- Antiplatelet antibody assay
Medicine
C. The blood smear shows decreased platelets but normal leukocytes and red cells. Nuclear medicine liver-spleen scan can determine the function of the liver and spleen and thus can assess for the presence of hypersplenism, which, if present, would indicate that platelet sequestration is at least a contributor to thrombocytopenia in this case.
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